Physician-patient discussions of controversial cancer screening tests

Background: Screening mammography for younger women and prostate-specific a ntigen (PSA) measurement have controversial benefits and known potential ad verse consequences. While providing informed consent and eliciting patient preference have been advocated for these tests, little is known about how o ften these discussions take place ol about barriers to these discussions. Methods: We administered a survey to medical house staff and attending phys icians practicing primary care. The sun ey examined physicians' likelihood of discussing screening mammography and PSA testing, and factors: influenci ng the frequency and quality of these discussions. Results: For the three scenarios, 16% to 34% of physicians stated that they do not discuss the screening tests. The likelihood of having a discussion was significantly associated with house staff physicians' belief that PSA s creening is advantageous; house staff and attending physicians' intention t o order a PSA test, and attending physicians intention to order a mammogram ; and a controversial indication for screening. The most commonly identifie d barriers to discussions were lack of time, the complexity of the topic, a nd a language barrier. Conclusions: Physicians report they often do not discuss cancer screening t ests with their patients. Our finding that physicians' beliefs and intentio n to older the tests, and extraneous factors such as time constraints and a language barrier, are associated with discussions indicates that some pati ents may be inappropriately denied the opportunity to choose whether to scr een for breast and prostate cancer.